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JJ > Seizures and Seizure Planning > Flashcards

Seizures and Seizure Planning Flashcards

1
Q

what are one of the most common neurological conditions seen in veterinary practice?

A

seizures

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2
Q

how many dogs present with seizures each year?

A

1 in 125

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3
Q

in what animals are seizures most commonly seen?

A

dogs but can be seen in cats

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4
Q

if seizures are seen in cats what is the usual cause?

A

usually secondary to another condition

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5
Q

what are the key considerations that must be made about an owner when their pet has a seizure?

A

it can be very distressing for the owner especially the first one as they don’t know what is going on

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6
Q

how do neurons transmit information in the normal brain?

A

through chemical and electrical signals

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7
Q

what are interneurons?

A

large group of inhibitory cells which regulate the neurons in the brain

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8
Q

how is a seizure caused?

A

balance between excitatory and inhibitory input is altered leading to hypersynchronisation of neurons and so a seizure

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9
Q

define hypersynchronisation

A

The excessive synchronization of the firing of neurons that leads to seizures

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10
Q

what is a seizure?

A

an abnormal, uncontrollable, hypersynchronus electrical activation of a large group of neurons which may produce convulsions, minor physical signs, cognitive disturbances or a combination of symptoms

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11
Q

what is an isolated seizure?

A

lasts less than 5 mins and animal fully recovers after

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12
Q

what is a cluster seizure?

A

2 or more seizures within a 24 hour period with complete recovery in between

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13
Q

what type of seizure is a neurological emergency?

A

status epilepticus

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14
Q

describe status epilepticus

A

seizure lasting longer than 5 minutes

2 seizures without complete recovery in between (so may seem continuous)

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15
Q

why is status epilepticus dangerous?

A

brain damage will occur and worsen the longer the seizure goes on

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16
Q

what are the 2 main types of seizure?

A

partial or focal

generalised (tonic / clonic)

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17
Q

what part of the brain is affected in a partial or focal seizure?

A

asymmetric - only one side

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18
Q

what are the signs of partial / focal seizures?

A

facial twitching
hypersalivation
behavioural changes
consciousness maintained

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19
Q

what are the 2 types of partial / focal seizure?

A

simple

complex

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20
Q

what is the difference between a simple and complex focal / partial seizure?

A

in simple there is no change in mentation whereas in complex change in mentation is seen

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21
Q

what areas of the brain are involved in generalised (tonic/clonic) seizures?

A

bilateral cerebral hemisphere involvement

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22
Q

describe what happens during a generalised (tonic/clonic) seizure

A 
autonomic signs (urinate and defecate)
loss of consciousness
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23
Q

what are the 3 phases of generalised (tonic/clonic) seizures?

A

pre-ictal
ictal
post-ictal

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24
Q

how long does the pre-ictal phase last for?

A

minuites

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25
Q

when does the pre-ictal phase occur?

A

before the seizure happens

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26
Q

what are the signs of the pre-ictal seizure phase?

A

may be subtle
behaviour changes
altered mentation
attention seeking behaviour

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27
Q

when does the ictal phase occur?

A

the actual seizure

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28
Q

what happens during the ictal phase?

A

loss of consciousness
muscle contraction
urination / defecation

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29
Q

when does the post-ictal phase occur?

A

after the seizure

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30
Q

how long does the post ictal phase of a seizure last?

A

minutes to days

depends on individual

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31
Q

what are the signs of the post-ictal phase?

A

abnormal neurological signs which may be subtle or marked

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32
Q

what are the 2 main extracranial causes of seizures?

A

toxins

metabolic

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33
Q

what are the main toxins which cause seizures?

A 
methaldehyde (slug bait)
ethylene glycol (antifreeze)
permethrin (cats)
pesticides
Ivermectin (collies)
human drugs
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34
Q

what are the metabolic causes of seizures?

A

portosystemic shunt
hypoglycaemia
hypocalcaemia

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35
Q

why can a postosystemic shunt lead to seizures?

A

change in blood flow will collect toxins from vessels that have been bypassed before shunt placed that are then moved around the body

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36
Q

what are the 2 main intracranial causes of seizures?

A

structural

functional

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37
Q

what are the structural causes of seizures?

A

brain tumor
inflammation
hydrocephalus

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38
Q

what is the functional cause of seizures?

A

idiopathic epilepsy

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39
Q

what is the most common cause of seizures?

A

idiopathic epilepsy

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40
Q

what age are animals that present with idiopathic epilepsy?

A

6 months to 6 years

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41
Q

what signs will suggest that an animal has idiopathic epilepsy?

A 
recurrent single seizures
normal inter-ictal neuro exam
normal metabolic investigation
normal brain MRI
normal CSF (if tap taken)
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42
Q

how is idiopathic epilepsy / seizure cause diagnosed?

A 
history
blood tests
MRI scan with contrast
CSF analysis
video assessment of seizure
monitoring and recording (e.g. seizure diary)
retinal exam
blood pressure (if possible)
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43
Q

what information can be gained when taking a history of a patient with seizures?

A

is it a true seizure

any history of toxin ingestion, head trauma or meidacation

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44
Q

what blood tests will be used to diagnose the cause of seizures?

A

haematology
biochem
fasted blood glucose
pre and post prandial bile acids

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45
Q

what contrast is used in MRI scans of the brain?

A

gadolinium

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46
Q

what is needed when preparing for CSF tap?

A

clip and surgical prep

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47
Q

what position must the animals head be held in for a CSF tap?

A

flexed downwards

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48
Q

why is important to know the difference between seizures and seizure mimics/

A

testing and mediaction are different

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49
Q

what are the main seizure mimic disorders?

A 
narcolepsy/cataplexy
fly-catching
movement disorder
syncope
3rd degree AV block
canine epileptoid cramping syndrome
peripheral vestibular disease
50
Q

what is narcolepsy/cataplexy?

A

sleep wake disorder - limbs will go floppy and animal will suddenly collapse

51
Q

describe how to identify narcolepsy/cataplexy

A 
collapses are flaccid
inherited
loss of muscle tone (increased in seizures)
no autonomic signs
will return to normal straight after
52
Q

what is the cause of fly-catching?

A

unknown

53
Q

what happens during fly-catching?

A

animal appears as if they are chasing or trying to catch imaginary flies

54
Q

how long can fly-catching last for?

A

minutes to hours

55
Q

is mentation altered during fly catching behaviour?

A

no - normal

56
Q

are there autonomic signs associated with fly-catching?

A

no

57
Q

describe movement disorder

A

episodic
patient remains conscious
involuntary movements that are spontaneous and uncontrolled
neurologically normal between episodes

58
Q

what is syncope often mistaken for?

A

narcolepsy / cataplexy

59
Q

what is syncope?

A

fainting - temporary loss of conciousness

60
Q

what causes syncope?

A

reduced oxygenation to the brain which is usually cardiac related

61
Q

what may cause syncope that is not cardiac related?

A

neurological
hypoglycaemia
hypocalcaemia

62
Q

describe how 3rd degree AV block differs from seizures

A

prolonged hypoxic event
partial seizure like presentation (may be wobbly)
but not actually seizing

63
Q

what dogs are most commonly affected by canine epileptiod cramping syndrome?

A

boarder terriers

64
Q

what is canine eplieptiod cramping syndrome?

A

movement disorder

65
Q

describe a canine eplieptiod cramping syndrome presentation

A 
conscious and responsive
no autonomic signs
normal mentation
cramping or stiffness
occurs during normal movement
66
Q

when should emergency seizure management only be performed?

A

under the guide/instruction of the VS

67
Q

what is involved in emergency management of the seizing patient?

A 
provide O2
place IV catheter when possible
administer diazepam
assess circulation and temp
intubate if needed
provide active cooling if hyperthermic
collect full bloods
68
Q

when will it not be possible to place an IV catheter?

A

in ictal phase of seizure

69
Q

how may diazepam be administered to the seizing patient?

A

IV bolus
rectally
intranasally

70
Q

what volume of diazepam is given IV in seizing patients?

A

0.5mg/kg

71
Q

what volume of diazepam is given rectally in seizing patients?

A

2mg/kg

72
Q

what volume of diazepam is given intranasally in seizing patients?

A

0.5 mg/kg

73
Q

when may you give mannitol (0.5 mg/kg) to a seizing patient?

A

IV (slowly) if seizure activity lasts more than 15 minutes or there is reason to suggest cerebral oedema and raised ICP

74
Q

what should be tested first when bloods are taken from a seizing patient?

A

glucose, electrolyte and calcium

75
Q

what should be done if the seizing patient is on phenobarbital?

A

collect baseline blood sample to assess drug conc. and see if alterations to prescription are needed

76
Q

what questions should be asked on phone triage to an owner of an animal that’s seizing?

A 
any history of seizures
known toxin exposure
known head trauma
length of seizure
how many seizures
is the patient conscious and responsive
any urination or defecation
77
Q

when should owners be advised to travel to the practice with their seizing pet?

A

when safe to do so - wait for recovery or until owner feels able

78
Q

what are the main considerations when nursing a seizure patient?

A

area of ward with least noise
lights dimmed wherever possible
bottom kennel
seizure plan on kennel with doses calculated
seizure pack with medication drawn up
sign on door to limit staff member entry and traffic

79
Q

what is the main goal of the environment around seizure patients?

A

quiet and calm as possible with as little stimulation as possible to reduce any potential seizure triggers

80
Q

what should you do if the patient you are caring for seizes?

A 
stay calm
note the time
inform vet in charge of case and ask for help
remove any surrounding dangers
dim the lights
reduce noise
limit handling once safe
monitor vital signs if possible
follow seizure plan if one in place
81
Q

what should you not do with a seizing patient?

A

put your hands in or near their mouth

82
Q

what must you try to get from the owner when they are calling with an emergency?

A

contact number in case you are cut off

83
Q

what should you do when a seizing patient arrives in hospital?

A 
reassure the owner
triage - ABC
O2 therapy
IV access ASAP
anticonvulsants
check temp 
active cooling if hyperthermia
mannitol, CRI and intubation if needed
84
Q

what is the aim of seizure management in an emergency?

A

stop the patient seizuring

85
Q

what is the aim of seizure management for recurrent seizures?

A

improve QOL for owner and patient
reduce seizure frequency
reduce severity
balance acceptable levels of side effects and cost

86
Q

what is essential for recurrent seizure management?

A

owner education and compliance

87
Q

what is the first line of treatment for medical management of idiopathic epilepsy?

A

Phenobarbitol (Epiphen)

88
Q

what receptors does Phenobarbitol work at?

A

barbituate that acts on GABA receptors in the brain

89
Q

how does phenobarbital have it’s effect?

A

increases frequency of synaptic inhibition and reduces neuronal excitability

90
Q

what are the benefits of Phenobarbital?

A

high efficacy
high safety
low cost

91
Q

how long does it take for plasma Phenobarbitol concentration to reach steady state?

A

~2 weeks

92
Q

what is the significance of steady state drug plasma concentration?

A

the level of drug required in the plasma to exert full effect

93
Q

why does Phenobarbital require regular blood tests?

A

to check steady state plasma conc

94
Q

what are the side effects of Phenobarbital?

A 
hepatotoxicity with high doses
sedation
polydipsia
polyuria
polyphagia
ataxia
95
Q

what symptoms usually decrease after the fist few weeks on Phenobarbital?

A

sedation
polydipsia
polyuria
polyphagia

96
Q

what drugs are used for medical management of idiopathic epilepsy?

A

Phenobarbital (Epiphen)
Potassium bromide (Libromide)
Levetiracetam (Keppra)
Imepitoin (Pexion)

97
Q

when is Potassium bromide often used?

A

used as first line AED or in conjunction with another AED

98
Q

what is the most common use of potassium bromide?

A

in conjunction with another AED

99
Q

what is the role of Potassium bromide?

A

reduced neuronal excitability

100
Q

how long does it take to achieve steady state plasma concentration of Potassium bromide?

A

~4 months

101
Q

how is Potassium bromide excreted?

A

renally - care in compromised patinets

102
Q

what is the issue with Potassium bromide in cats?

A

can cause serious lung issues

103
Q

what are the side effects of Potassium bromide?

A 
gastric irritation
nausea
polydipsia
polyuria
sedation
pancreatitis
104
Q

what is the method of action of Levtiracetam (Keppra)?

A

unknown

105
Q

what is Levtiracetam (Keppra) used for?

A

adjunct to other AEDs

106
Q

why is Levtiracetam (Keppra) safe for patients with kidney disease?

A

primarily excreted unchanged in the urine

107
Q

how is Levtiracetam (Keppra) excreted?

A

unchanged via the kidneys

108
Q

what are the advantages of Levtiracetam (Keppra)?

A

excellent oral bioavailability
well tolerated with few side effects
safe for kidney patients

109
Q

what are the side effects of Levtiracetam (Keppra)?

A

ataxia
vomiting
sedation

110
Q

what is Imepitoin (Pexion) licenced for?

A

idiopathic epilepsy only

111
Q

what receptors does Imepitoin (Pexion) act on?

A

GABA receptors

112
Q

how does Imepitoin (Pexion) work?

A

reduced electrical activity of GABA receptors

113
Q

what animals should not be given Imepitoin (Pexion)?

A

dogs with impaired hepatic function, renal or cardiovascular disorders

114
Q

what are the side effects of Imepitoin (Pexion)?

A

ataxia
vomiting
polyphagia

115
Q

what other AEDs may be used to manage seizures?

A

gabapentin
diazepam
zonisimide
(all less effectie)

116
Q

what are the main home care considerations for seizure patients?

A 
manage owner expectations
family situation
financial situation
type of property
communication
build client trust and a rapport
encourage repeat visits
117
Q

what must be considered about family situation when creating a seizure home care plan?

A

work patterns
children (drugs and distress from seizures)
ability to administer medication on time and reliably

118
Q

what must be considered about financial situation when creating a seizure home care plan?

A

medication is lifelong
there will be repeated blood tests and consults
medication may be altered and added to

119
Q

what must be considered about the type of property when creating a seizure home care plan?

A

access for patient

is garden safe (e.g. steps they could fall down)

120
Q

what must be considered about communication when creating a seizure home care plan?

A

involve the whole family inculding children

121
Q

what are the main things to consider offering to clients with a seizure dog in terms of support?

A

nursing consultations after initial diagnosis
follow up calls to check in
written communication
support groups / evening sessions for clients

JJ (33 decks)

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